Parenteral nutrition associated liver disease (PNALD) is a significant complication in infants receiving long-term parenteral nutrition (PN). Chronic administration of PN has been associated with its development. Our ...Parenteral nutrition associated liver disease (PNALD) is a significant complication in infants receiving long-term parenteral nutrition (PN). Chronic administration of PN has been associated with its development. Our purpose is to characterize our incidence of PNALD over an extended period and identify risk factors for its development, including administration of soybean-based injectable lipid emulsions (ILEs) as we transit to novel ILEs</span><span style="font-family:Verdana;"> in our practice</span><span style="font-family:Verdana;">. Infants receiving 30 days or more of PN were included. PNALD was defined as a direct bilirubin ≥ 2 mg/dL. Data collected included: patient demographics, clinical and enteral feeding characteristics. Macronutrient intake was recorded using these cut-offs: glucose infusion rate (GIR) of ≤14 mg/kg/min or above, protein doses of ≤3 g/kg/day or above and lipid doses of ≤2 g/kg/day or above.</span><span style="font-family:""> </span><span style="font-family:Verdana;">A total of 349 infants were included, with an annual incidence of PNALD ranging between 34</span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">54%. Infants with PNALD were younger by gestation (27 vs. 29.5 weeks) and smaller by birthweight (900 vs. 1248 grams). Sepsis, GI disease including necrotizing enterocolitis and bowel resection were significantly associated with an increased risk for development of PNALD. PNALD infants received lower protein doses (3.0 vs 3.3 g/kg/day, p = 0.014) while receiving higher GIR (11.4 vs 10.7 mg/kg/min, p = 0.012) compared to non-PNALD infants. Low birth weight, sepsis and bowel resection remain strong indicators of risk for PNALD. No single macronutrient increased our infants’ risk for PNALD. The use of newer ILEs when available should be evaluated for their impact on PNALD development.展开更多
With the advent of new, particularly mixed-oil lipid emulsions approved by the United States Food & Drug Administration (FDA), clinicians have more options when choosing one as part of the parenteral nutrition sup...With the advent of new, particularly mixed-oil lipid emulsions approved by the United States Food & Drug Administration (FDA), clinicians have more options when choosing one as part of the parenteral nutrition support of patients. Lipid products long-standing availability in Europe and other parts of the world has certainly facilitated the process in the United States, where there was little evolution before 2014. These newer oil-based emulsions are finding their way to be used in pediatrics, as studies are being carried out that will result in pediatric labeling. Pediatric clinicians may find themselves wondering how these lipid emulsions are different from those that have come before;whether the same dosing or administration practices apply as with the traditional soybean-oil lipid emulsion, and if they can be used for other more emergent interventions. We present this review of the current lipid emulsions available in the U.S. market, highlighting the differences among them, as well as, providing some practical information for clinicians that can assist them in their day-to-day duties.展开更多
文摘Parenteral nutrition associated liver disease (PNALD) is a significant complication in infants receiving long-term parenteral nutrition (PN). Chronic administration of PN has been associated with its development. Our purpose is to characterize our incidence of PNALD over an extended period and identify risk factors for its development, including administration of soybean-based injectable lipid emulsions (ILEs) as we transit to novel ILEs</span><span style="font-family:Verdana;"> in our practice</span><span style="font-family:Verdana;">. Infants receiving 30 days or more of PN were included. PNALD was defined as a direct bilirubin ≥ 2 mg/dL. Data collected included: patient demographics, clinical and enteral feeding characteristics. Macronutrient intake was recorded using these cut-offs: glucose infusion rate (GIR) of ≤14 mg/kg/min or above, protein doses of ≤3 g/kg/day or above and lipid doses of ≤2 g/kg/day or above.</span><span style="font-family:""> </span><span style="font-family:Verdana;">A total of 349 infants were included, with an annual incidence of PNALD ranging between 34</span><span style="font-family:Verdana;">% </span><span style="font-family:Verdana;">-</span><span style="font-family:""> </span><span style="font-family:Verdana;">54%. Infants with PNALD were younger by gestation (27 vs. 29.5 weeks) and smaller by birthweight (900 vs. 1248 grams). Sepsis, GI disease including necrotizing enterocolitis and bowel resection were significantly associated with an increased risk for development of PNALD. PNALD infants received lower protein doses (3.0 vs 3.3 g/kg/day, p = 0.014) while receiving higher GIR (11.4 vs 10.7 mg/kg/min, p = 0.012) compared to non-PNALD infants. Low birth weight, sepsis and bowel resection remain strong indicators of risk for PNALD. No single macronutrient increased our infants’ risk for PNALD. The use of newer ILEs when available should be evaluated for their impact on PNALD development.
文摘With the advent of new, particularly mixed-oil lipid emulsions approved by the United States Food & Drug Administration (FDA), clinicians have more options when choosing one as part of the parenteral nutrition support of patients. Lipid products long-standing availability in Europe and other parts of the world has certainly facilitated the process in the United States, where there was little evolution before 2014. These newer oil-based emulsions are finding their way to be used in pediatrics, as studies are being carried out that will result in pediatric labeling. Pediatric clinicians may find themselves wondering how these lipid emulsions are different from those that have come before;whether the same dosing or administration practices apply as with the traditional soybean-oil lipid emulsion, and if they can be used for other more emergent interventions. We present this review of the current lipid emulsions available in the U.S. market, highlighting the differences among them, as well as, providing some practical information for clinicians that can assist them in their day-to-day duties.
